SAT0614 DOES DRUG EFFECTIVENESS OF 2ND AND 3RD TNF INHIBITORS IN PATIENTS WITH PSORIATIC ARTHRITIS DEPEND ON THE REASON FOR WITHDRAWAL FROM THE PREVIOUS TREATMENT? – RESULTS FROM THE EUROSPA RESEARCH COLLABORATION
Authors: Cecilie Heegaard Brahe, Lykke Ørnbjerg, Lennart T.H. Jacobsson, Michael Nissen, Eirik Kristianslund, Heřman Mann, Maria Jose Santos, Manuel Pombo-Suarez, Dan Nordström, Ziga Rotar, Björn Gudbjornsson, Ediz Dalkiliç, Catalin Codreanu, Anne Gitte Loft, Ulf Lindström, Burkhard Moeller, Joe Sexton, Karel Pavelka, Anabela Barcelos, Carlos Sánchez-Piedra, Kari Eklund, Matija Tomsic, Thorvardur Jon Love, İsmail Sari, Ruxandra Ionescu, Marleen van de Sande, Irene van der Horst-Bruinsma, Gareth T. Jones, Florenzo Iannone, Brigitte Michelsen, Lise Hyldstrup, Niels Steen Krogh, Mikkel Östergaard, Merete L. Hetland
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Tumour necrosis factor inhibitors (TNFi) are efficacious in patients with psoriatic arthritis (PsA), but some patients switch to a different TNFi because of adverse events (AE) or lack of effect (LOE). The EuroSpA Collaboration has previously demonstrated a 1-year retention rate of 77% and 6 months LUNDEX adjusted 28-joint count Disease Activity Score (DAS28) remission rates of 45%<sup>1</sup> in patients with PsA initiating the first TNFi treatment. Little is known about the effectiveness of switching to a second and third TNFi in patients with PsA. <h3>Objectives</h3> Firstly, to investigate retention and remission rates at 6, 12 and 24 months in patients with PsA initiating the 2<sup>nd</sup> and 3<sup>rd</sup> TNFi in clinical practice across Europe. Secondly, to investigate whether the outcomes are associated with the reason for withdrawal (AE or LOE) from the previous TNFi-treatment. <h3>Methods</h3> Prospectively collected data on PsA patients in routine care from 12 European registries were pooled. Kaplan-Meier estimation was used to investigate TNFi retention rates. LUNDEX adjusted<sup>2</sup> remission rates were calculated for DAS28&lt;2.6 and 28 joint Disease Activity index for Psoriatic Arthritis (DAPSA28) ≤4. Group comparisons were performed by Chi-square test. <h3>Results</h3> A total of 4971 patients initiating their 2<sup>nd</sup>TNFi and 1768 patients initiating their 3<sup>rd</sup> TNFi were included. Baseline characteristics are shown in the Table. The overall retention rates for 2<sup>nd</sup> and 3<sup>rd</sup> TNFi at 12 months were 69% (67-70%) and 66% (64-68%), (2<sup>nd</sup> vs 3<sup>rd</sup> p=0.053), respectively (<b>Figure</b>). Corresponding retention rates for the individual registries ranged from 48-100% and 49-91%, respectively. If patients had stopped the 1<sup>st</sup> TNFi due to AE or LOE, 12-month retention rates for the 2<sup>nd</sup> TNFi treatment were 66% and 65%, respectively. In patients who stopped the 2<sup>nd</sup> TNFi due to AE or LOE, 12-month retention rates for the 3<sup>rd</sup> TNFi treatment were 65% and 63%, respectively. For the 2<sup>nd</sup> and 3<sup>rd</sup> TNFi, 6 months LUNDEX adjusted DAS28 remission rates were 35% and 27% (p&lt;0.001), respectively, and for DAPSA28 remission 14% and 10% (p=0.008) (<b>Table</b>). <h3>Conclusion</h3> The EuroSpA Collaboration demonstrated decreasing retention and remission rates with increasing number of previous TNFi, although with only minor difference between 2<sup>nd</sup> and 3rd. Patients who had withdrawn from the previous TNFi due to LOE had retention rates and remission rates similar to those who had withdrawn due to AE. <h3>References</h3> [1] Brahe, et al. ACR 2018 [2] Arthritis Rheum, 2006, 54(2), p:600-6 <h3>Acknowledgement</h3> Novartis Pharma AG and IQVIA for supporting the EuroSpA collaboration. <h3>Disclosure of Interests</h3> Cecilie Heegaard Brahe Grant/research support from: Unrestricted grant: Novartis, Lykke Ørnbjerg Grant/research support from: Unrestricted grant: Novartis, Lennart T.H. Jacobsson Consultant for: LJ has received lecture and consulting fees from Pfizer, Abbvie, Novartis, Eli-Lily and Janssen, Michael Nissen Consultant for: AbbVie, Lilly, Novartis, and Pfizer, Eirik kristianslund: None declared, Heřman Mann Consultant for: Pfizer, Eli Lilly, Sanofi, Speakers bureau: AbbVie, Roche, Pfizer, MSD, Eli Lilly, Sanofi, Maria Jose Santos: None declared, Manuel Pombo-Suarez: None declared, Dan Nordström Grant/research support from: MSD, Pfizer, Consultant for: AbbVie, BMS, MSD, Novartis, Roche, Pfizer, UCB, Speakers bureau: Novartis, UCB, Ziga Rotar: None declared, Björn Gudbjornsson: None declared, Ediz Dalkiliç Grant/research support from: MSD and Abbvie, Consultant for: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Catalin Codreanu: None declared, Anne Gitte Loft: None declared, Ulf Lindström: None declared, Burkhard Moeller Consultant for: Swissmedic Human Medicines Expert Committee Member (regulatory agency), Joe Sexton: None declared, Karel Pavelka: None declared, Anabela Barcelos: None declared, Carlos Sánchez-Piedra: None declared, Kari Eklund: None declared, Matija Tomsic: None declared, Thorvardur Jon Love Consultant for: Received reimbursment from Celgene for speaking about guidelines for the treatment of psoriatic arthritis, İsmail Sari: None declared, Ruxandra Ionescu: None declared, Marleen van de Sande Grant/research support from: van Janssen, Novartis, Eli Lily, Consultant for: Novartis and Abbvie, Irene van der Horst-Bruinsma Grant/research support from: MSD, Pfizer, AbbVie, Consultant for: Abbvie, UCB, MSD, Novartis, Speakers bureau: BMS, AbbVie, Pfizer, MSD, Gareth T. Jones Grant/research support from: Have received research grants (not current) from Abbvie and Pfizer. Have received research grants (not current) from the British Society for Rheumatology, who received the funds from Abbive, Pfizer and UCB. Have received research grant (current) from the British Society for Rheumatology, who received the funds from Celgene., Florenzo Iannone Consultant for: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Speakers bureau: F Iannone has received consultancy fees and/or speaker honoraria from Pfizer, AbbVie, MSD, BMS, Novartis, Lilly, UCB outside this work, Brigitte Michelsen: None declared, Lise Hyldstrup: None declared, Niels Steen Krogh: None declared, Mikkel Östergaard Grant/research support from: Abbvie, Celgene, Centocor, Merck, Novartis, Consultant for: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, and UCB, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen, Pfizer, Consultant for: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck, Samsung Bioepis